HOW TO MAKE A HEALTH INSURANCE CLAIM

Step one

Being referred for treatment

Your consultation or treatment must follow an initial referral by a GP (including via a digital GP service) or dentist or another healthcare practitioner. The situations in which we will accept such a referral are set out on Bupa's website.

For muscle, bone or joint pain, see the ‘MSK Direct Access’ explanation on this page.

Step two

You need to call us on 0330 018 0778 or you can contact us digitally by visiting Bupa's website or downloading the Bupa Touch App.

To help us make the claims process as simple and swift as possible, please have the following information close to hand when you call us:

• your policy number
• details of the condition you are suffering from
• details of when your symptoms first began
• details of when you first consulted a GP about your condition
• details of the treatment that has been recommended.

Step three

We will explain which nearby specialists, facilities and healthcare professionals are available under your benefits and provide you with a pre-authorisation number so your healthcare provider can send the bill directly to us.

If your specialist recommends further tests or treatment, it is important you check back with us to obtain further pre-authorisation.

We strongly advise you to call us before arranging or receiving any treatment to pre-authorise it, as you will be responsible for paying any fees or charges that are not covered under your benefits.

Step four

Usually, we will pay the providers of your treatment directly

Please send any correspondence to: Bupa Claims, Bupa Place, 102 The Quays, Salford M50 3SP.

Step one

Being referred for treatment

Your consultation or treatment must follow an initial referral by a GP (including via a digital GP service) or dentist or another healthcare practitioner. The situations in which we will accept such a referral are set out on Bupa's website.

For muscle, bone or joint pain, see the ‘MSK Direct Access’ explanation on this page.

Step two

You need to call us on 0330 018 0778 or you can contact us digitally by visiting Bupa's website or downloading the Bupa Touch App.

To help us make the claims process as simple and swift as possible, please have the following information close to hand when you call us:

• your policy number
• details of the condition you are suffering from
• details of when your symptoms first began
• details of when you first consulted a GP about your condition
• details of the treatment that has been recommended.

Step three

We will explain which nearby specialists, facilities and healthcare professionals are available under your benefits and provide you with a pre-authorisation number so your healthcare provider can send the bill directly to us.

If your specialist recommends further tests or treatment, it is important you check back with us to obtain further pre-authorisation.

We strongly advise you to call us before arranging or receiving any treatment to pre-authorise it, as you will be responsible for paying any fees or charges that are not covered under your benefits.

Step four

Usually, we will pay the providers of your treatment directly

Please send any correspondence to: Bupa Claims, Bupa Place, 102 The Quays, Salford M50 3SP.

If your policy started or renewed on or after 1 December 2023 and you want to claim on your Health Cash Benefits Cover, follow these steps:

Dental claims

To claim on the dental element of you Health Cash Benefits Cover, please download the claim form and follow the instructions.

All other claims

For all the other elements of your Health Cash Benefits cover a claim form is not required. Instead, we just require a receipt or invoice that shows the following details:

• name of the person receiving treatment
• date treatment took place
• details of treatment received including cost of each
• the service provider name
• proof that you paid for the treatment

Please send all correspondence (including your name and policy number) to:

Bupa Claims, Bupa Place, 102 The Quays, Salford M50 3SP.

Step one

Your GP or dentist refers you to a specialist for private treatment. (For muscle, bone and joint pain refer to the 'Working Body' explanation on this page.)

Step two

Call the Saga Health Insurance claims team on 0800 027 1331 to check that treatment is eligible but please remember that cover for your claim can only be confirmed once we have received the completed claim form.

Please help us by having the following details available:

• Specialist/specialist type or group practice name
• Hospital name and any admission dates
• A procedure code if you are having a surgical procedure
• Details of your medical condition, particularly if your policy excludes cover for treatment of pre-existing conditions.

Step three

We will then:

• Check that we will pay the specialist's fee in full or find a specialist for you
• Confirm which hospitals are covered
• Send you a partially completed claim form.

Step four

Complete your section of the Saga Health Insurance claim form, answering all the questions. Ensure you include the date you first became aware of the condition you are claiming for, and if you have experienced similar symptoms before, tell us when.

Ask your GP to complete the remainder of the claim form and return it to us at the address shown on the form.

Step five

Once we have received your completed claim form we will then:

• Assess the claim and confirm whether we will cover the treatment
• Remind you of any benefit restrictions that may affect your claim.

Step six

Send in any outstanding accounts for treatment to our Claims Personal Advisory Team.

Please send any correspondence to: Saga Claims Personal Advisory Team, International House, Forest Road, Tunbridge Wells, TN2 5FE.

Step one

Your GP provides an open referral for private treatment. (For muscle, bone and joint pain refer to the 'Working Body' explanation on this page).

Step two

You need to call us on 0800 027 1331 to check that treatment is eligible but please remember that cover for your claim can only be confirmed once we have received the completed claim form.

• Specialist type
• Preferred hospital name and any admission dates
• A procedure code if you are having a surgical procedure
• Details of your medical condition, particularly if your policy excludes cover for treatment of pre-existing conditions.

Step three

We will then:

• Check that the treatment is eligible based on the information provided over the phone
• Send you a claim form (if required)
• Find up to three selected providers, who you're allowed to receive eligible treatment from, for you to choose between
• Provide you with details of the selected provider. If you need to see a specialist, we can book the initial appointment for you. In order to book your appointment with the specialist we will need to share some personal information with them, including medical information. In some circumstances, it may be necessary or you may prefer to make the appointment with the specialist yourself.

Step four

Complete your section of the Saga Health Insurance claim form, answering all the questions. Ensure you include the date you first became aware of the condition you are claiming for, and if you have experienced similar symptoms before, tell us when.

Ask your GP to complete the remainder of the claim form and return it to us at the address shown on the form.

Step five

Once we have received your completed claim form we will then:

• Assess the claim and confirm whether we will cover the treatment
• Remind you of any benefit restrictions that may affect your claim
• In most of the cases - and provided that your claim form has been completed correctly - we should be able to give you an answer within two working days.

Step six

Send in any outstanding accounts for treatment to our Claims Personal Advisory Team.

Please send any correspondence to: Saga Claims Personal Advisory Team, International House, Forest Road, Tunbridge Wells, TN2 5FE.

If your policy started or renewed before 1 December 2023 and you want to make a claim under your Health Cash Benefits Cover, please download the claim form and follow the instructions.

This is the amount you’ve chosen to contribute towards your treatments. You’ll only pay this once a year for each person who claims. Having an excess lowers your premium.

If the procedure or invasive diagnostic test is not available for you through the NHS within four or six weeks of when you need it, depending on the option you've selected, we’ll get you seen privately.

You’ll have chosen this to lower your premium when you signed up to your Saga plan.

This is a discount added to your policy each year based on your claims history. The No Claim Discount rises annually by 5% to a maximum of 60% if no claims are made. (Please see your Policy Book for more information on NCD).

Your current NCD level is shown on your Policy Schedule. This is how the NCD level is calculated:

• Where nobody covered on the policy makes a claim - The NCD for the policy is increased by one level at the following policy renewal date until level 10 is reached
• For each claim made on the policy - The NCD for the policy is reduced by two levels at the following policy renewal date for each claim made until level 0 is reached.

These are the NCD levels and their discount percentage on a basic premium rate:

• Level 0 = 0%
• Level 1 = 10%
• Level 2 = 20%
• Level 3 = 25%
• Level 4 = 30%
• Level 5 = 35%
• Level 6 = 40%
• Level 7 = 45%
• Level 8 = 50%
• Level 9 = 55%
• Level 10 = 60%

For policies with a start or renewal date on or after 1 December 2023

You can create an account online by visiting Bupa online or download the Bupa Touch App. From here you can call or use Webchat to get in touch, pre-authorise treatment and view your claims history.

For policies with a start or renewal date before 1 December 2023

Yes, you can start a claim or pre-authorise treatment online.

You can also check the progress of claims you’ve made, upload documents and invoices, update your details and message us about your policy. It’s easy to use, secure and personal to you.

Not if you see one of our fee-assured specialists and your treatment is covered by your policy. If you choose a specialist that is not approved by us, or one that charges more than our approved fee limits, you may have to pay some or all of your treatment costs yourself.

Check your Policy Book for more details on treatments and what is and isn’t covered by your policy.